Provider Demographics
NPI:1063126431
Name:VANDUNK, DENNIS W III (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:VANDUNK
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MOCCASSIN PL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2106
Mailing Address - Country:US
Mailing Address - Phone:845-323-6379
Mailing Address - Fax:
Practice Address - Street 1:110 EAST 58TH ST.
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2106
Practice Address - Country:US
Practice Address - Phone:212-434-4650
Practice Address - Fax:212-288-1462
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant